Special Orthopedic Tests : Knee

Question 1

Abduction (Valgus Stress) Test

Answer 1

Process :
1. Examiner applies in adduction force at the knee (0 degrees & 30 degrees flexion) while stabilizing client’s distal lower leg with the other hand
+ve Sign : Excessive movement, altered pain
+ve Indicates : Medial collateral ligament sprain

Question 2

Adduction (Varus Stress) Test

Answer 2

Process :
1. Examiner applies an abduction force at the knee (at 0 degrees & 30 degrees flexion) while stabilizing client’s distal lower leg with the other hand
+ve Sign : Laxity, altered pain
+ve Indicates : Lateral collateral ligament sprain

Question 3

Drawer Sign

Answer 3

Process :
1. Client supine with knee flexed to 90 degrees & hip flexed to 45 degrees
2. Client’s foot stabilized in neutral on table by examiner sitting on client’s forefoot
3. Examiner’s hands placed around tibia & then tibia is
- Drawn forward
- Pushed posterior
+ve Sign : Excessive movement, pain
+ve Indicates :
- Anterior cruciate ligament sprain
- Posterior cruciate ligament sprain

Question 4

Lachman Test

Answer 4

Process :
1. Client supine; examiner holds knee between full extension & 30 degrees flexion, and stabilizes femur with outside hand while proximal tibia moved anterior with inside hand
+ve Sign : Excessive movement, “mushy” or soft end feel, disappearance of infrapatellar tendon slope
+ve Indicates : Anterior cruciate ligament sprain

Question 5

Posterior Sag Sign (Gravity Drawer Test)

Answer 5

Process : Client supine with knee flexed 90 degrees & hip flexed 45 degrees
+ve Sign : Tibia “drops back”
+ve Indicates : Posterior cruciate ligament sprain

Question 6

Reverse Lachman Test

Answer 6

Process :
Client prone; examiner
1. hold client’s knee flexed 30 degrees
2. Grasp tibia with one hand while fixing femur with other hand
3. Pull tibia posterior
+ve Sign : Excessive movement, “mushy” or soft end feel
+ve Indicates : Posterior cruciate ligament sprain

Question 7

Apley’s Test

Answer 7

Process :
Client prone with knee flexed 90 degrees; examiner will
1. Anchor client’s thighs to table with own knee
2. Distract knee, medially & then laterally rotate knee
3. Compress knee, medially & then laterally rotate knee
+ve Sign :
Distraction - more painful, increased movement
Compression - more painful, decreased rotation
+ve Indicates :
Distraction - ligamentous lesion
Compression - meniscus tear

Question 8

“Bounce Home” Test

Answer 8

Process :
1. Client supine; examiner cups heel with client’s knee completely flexed & knee is passively allowed to extend
+ve Sign : Extension not complete or has a springy block end feel, sharp pain at joint line
+ve Indicates : Meniscus tear

Question 9

McMurray Test

Answer 9

Process :
1. Client supine, knee completely flexed with heel to glutes; examiner will
- Medially rotates tibia & extends knee (lateral meniscus)
- Laterally rotates tibia & extends knee (medial meniscus)
+ve Sign : Snap or click often accompanied by pain
+ve Indicates : Meniscus tear

Question 10

Brush / Stroke / Bulge / Wipe Test

Answer 10

Process :
1. Examiner commences just below joint line on medial side of patella, stroking proximally toward client’s hip & with opposite hand strokes down lateral side of patella
+ve Sign : A wave of fluid passes to medial side of joint & bulges just below medial distal portion / border of patella
+ve Indicates : Minimal effusion

Question 11

Patellar Tap / Ballotable Patella Test

Answer 11

Process :
1. Client’s knee extended or flexed to discomfort
2. Examiner applies a slight tap or overpressure the patella
+ve Sign : Patella is felt to be floating / “dancing”
+ve Indicates : Major effusion

Question 12

Clarke’s Sign (Patellar Grind Test)

Answer 12

Process :
1. Client supine with knee extended; examiner presses down slightly proximal to base of patella with web of hand
2. Client then contracts quadriceps while examiner pushes down
+ve Sign : Retropatellar pain & patient cannot hold contraction
+ve Indicates : Patellofemoral dsyfunction

Question 13

McConnell Test for Chondromalacia Patellae

Answer 13

Process :
1. Patient sitting with femur laterally rotated; performs isometric quadriceps contractions at 120, 90, 60, 30 and 0 degrees for 10 seconds each
2. If pain is produced during any of the contractions, a medial patellar glide is maintained while the knee is passively returned to the painful angle, supported by examiner’s knee and isometric contraction is repeated; each angle is tested in a similar fashion
+ve Sign : Decreased pain
+ve Indicates : Patellofemoral syndrome, patella chondromalacia

Question 14

Waldron Test

Answer 14

Process :
1. Examiner palpates patella while client performs several slow deep squats
+ve Sign : Crepitus & pain
+ve Indicates : Patellofemoral dysfunction

Question 15

Fairbank’s Apprehension Test

Answer 15

Process :
1. Client supine, quadriceps relaxed & knee flexed 30 degrees; examiner carefully pushes patella laterally
+ve Sign : Quadriceps contraction and/or apprehension
+ve Indicates : Patellar instability